Sunday, November 1, 2009
Patricia Newell-Helfant, MS, RNC, CPNP
Women's and Children's Services, St. Peter's Hospital, Albany, NY
Maureen Cavanagh, MS, MAHCM, RN
Women and Children's Services, St. Peter's Hospital, Albany, NY
Learning Objective 1: describe the challenges associated with acute inpatient care of newborns who have been exposed to opiates in utero.
Learning Objective 2: identify the benefits of treating opiate exposed newborns and their families in a therapeutic inpatient environment.
Historically, infants born to opiate addicted mothers (whether on methadone or not) have been cared for in the intensive care nursery so that these infants may be assessed for neonatal abstinence syndrome and safely withdrawn from their dependence on opiates. These infants are often difficult to console, easily over-stimulated by their surrounding environment and experience feeding difficulties. The acute intensive care environment of the NICU is not developmentally appropriate for the term neonate who has care needs because of opiate exposure but who is not critically ill. Additionally, NICU staff have expertise in critical care skills and the provision of basic infant care skill education to new parents. They do not generally have expertise or comfort in fostering parenting behaviors or in discussing challenging parenting issue. Within the division of Women’s and Children’s services, this expertise is most often found in the Pediatric setting and a creative multidisciplinary program utilizing both NICU and Pediatric Nursing staff was initiated.
The following program components will be shared:
1. Steps for initial stabilization of the opiate exposed neonate in the NICU
2. Transfer to the Pediatric unit after stabilization
3. Creation of therapeutic clinical weaning program
4. Parenting assessment and education
5. Social work link to mother’s methadone program
6. Creation of a space where the mother can “room in” with infant and provide as much care as possible in a supportive environment.
7. Complementary therapy modalities employed for both mother and infant
8. Comprehensive discharge planning.
Program outcomes will be reflected as the result of qualitative interviews being conducted with mothers who participate in the program. In addition, the readmission rates for the neonates, incidence of maternal co-morbidity of post partum depression and drug addiction relapse will also be analyzed.
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